An effective doctor–patient relationship is integral when providing and receiving healthcare services. Doctors with good communication skills prevent more medical crises and provide better support for their patients leading to more positive outcome.[1] Doctor–patient interactions are both verbal and non-verbal. Body-language, gestures, and facial expressions play a key role in nonverbal communication.[2] Moreover, inspection of facial features might shed light on the diagnosis of patients with neurological and psychiatric disorders. Currently, due the COVID-19 pandemic, face masks have become the norm to contain the spread of the novel coronavirus. The use of face masks by doctors and patients has created a physical barrier in seeing facial expressions. This could negatively impact their relationship as doctor's expressions of empathy and compassion are missed during consultations.[3] Therefore, the aim of this survey is to investigate whether wearing masks have affected doctor–patient relationship during the pandemic.
Ethics committee approval was obtained and all participants signed written informed consent form. This survey was conducted at a single, tertiary care neuroscience-hospital. Data were collected by interviewing patients from the out-patient department while doctors were asked to complete an online survey. All views were gathered using the Consultation and Relational Empathy measure which is a five-point Likert scale consisting of 10 questions.[4]
A total of 130 patients and 32 doctors (neurologists, neurosurgeon, and neuropsychiatrist) were interviewed for this survey. The mean age of the patients was 51 years. The ratio of male and female were 78:52. Doctors believed (56% somewhat agree) that their capability of making patients feel at ease was reduced due to masks while patients felt the opposite (52% strongly disagree). At large, patients felt that doctor's capability of letting them share their “story” did not reduce (53% strongly disagree, 33% somewhat disagreed) but doctor's felt the opposite (41% somewhat agreed). The reaction regarding the capability of doctors showing care and compassion reduction was comparable (59% doctors and 67% patients strongly disagreed) as described in [Table 1]. Doctors believed face-mask had reduced their capability of explaining things (34% somewhat agreed) as well as making treatment plan (44%) to some extent. Maximum doctors (94%) felt that mask has reduced the work speed in the clinical setting while examining the patients.
Table 1.
Perception of patients and doctors regarding usage of face-mask during clinical consultation
| Questions | Responses | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| Strongly agree | Somewhat agree | Neither agree nor disagree | Somewhat disagree | Strongly disagree | ||||||
| While wearing a face mask has: | Doctors | Patients | Doctors | Patients | Doctors | Patients | Doctors | Patients | Doctors | Patients |
| Doctor’s ability to make patient feel at ease reduced | 13% | 2% | 56% | 11% | 13% | 2% | 16% | 33% | 3% | 52% |
| Doctor’s ability to let patient tell their “story” reduced | 16% | 2% | 41% | 11% | 0% | 1% | 34% | 33% | 9% | 53% |
| Doctor’s ability to really listen to patients reduced | 13% | 0% | 31% | 8% | 0% | 2% | 31% | 32% | 25% | 59% |
| Doctor’s Interest in patients as a whole reduced | 13% | 0% | 9% | 3% | 3% | 2% | 25% | 28% | 50% | 67% |
| Doctor’s ability to fully understand patient concerns reduced | 13% | 0% | 9% | 5% | 3% | 2% | 25% | 29% | 50% | 64% |
| Doctor’s capability of showing care and compassion reduced | 6% | 0% | 25% | 2% | 0% | 2% | 9% | 29% | 59% | 67% |
| Doctor’s capability of being positive reduced | 6% | 1% | 13% | 2% | 9% | 4% | 25% | 37% | 47% | 56% |
| Doctor’s capability to clearly explain things reduced | 6% | 0% | 34% | 6% | 16% | 2% | 13% | 33% | 31% | 59% |
| Doctor’s ability in helping patients to take control reduced | 9% | 1% | 16% | 4% | 19% | 5% | 41% | 38% | 16% | 52% |
| Doctor’s ability to make a plan of action with patient reduced | 9% | 2% | 6% | 5% | 3% | 1% | 44% | 36% | 38% | 57% |
In this pandemic, the usage of mask is absolutely necessary but it undoubtedly affects doctor-patient interactions. This survey observed perception of doctors and patients regarding usage of facemasks during daily consultations. Patients did not feel much hindrance in explaining their concern to the doctors. But doctors had difficulty during practice and occasionally felt the urge to remove the masks for the sake of detailed clinical examination. Previous studies suggested a significant negative impact on the patient's perceived empathy and diminish the positive effects of relational continuity which differs from our study finding possibly due to cultural differences across countries.[5] Although, future research with a large sample size could compare the cross-cultural difference and further explain this complex observation, but the authors sincerely hope that we will see the end of the pandemic soon and use of mask during routine clinical interaction becomes optional.
Financial support and sponsorship
Research costs were covered by the Institute of Neurosciences Kolkata research fund.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Stewart MA. Effective physician-patient communication and health outcomes: A review. CMAJ. 1995;152:1423–33. [PMC free article] [PubMed] [Google Scholar]
- 2.Pamungkasih W, Sutomo AH, Agusno M. Description of patient acceptance of use of mask by doctor at poly out-patient care Puskesmas, Bantul. Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) 2019;2(2):70–75. [Google Scholar]
- 3.Tang JI, Shakespeare TP, Zhang XJ, Lu JJ, Liang S, Wynne CJ, et al. Patient satisfaction with doctor–patient interaction in a radiotherapy centre during the severe acute respiratory syndrome outbreak. Australas Radiol. 2005;49:304–11. doi: 10.1111/j.1440-1673.2005.01467.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Mercer SW, Maxwell M, Heaney D, Watt G. The consultation and relational empathy (CARE) measure: Development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21:699–705. doi: 10.1093/fampra/cmh621. [DOI] [PubMed] [Google Scholar]
- 5.Wong CK, Yip BH, Mercer S, Griffiths S, Kung K, Wong MC, et al. Effect of facemasks on empathy and relational continuity: A randomised controlled trial in primary care. BMC Fam Pract. 2013;14:1–7. doi: 10.1186/1471-2296-14-200. [DOI] [PMC free article] [PubMed] [Google Scholar]